Multiple Surgeries Research Articles

Quality of Life in Children with Congenital Birth Defects

Background: Congenital birth defects are a leading cause of morbidity and mortality in children, with significant long-term impacts on health and quality of life (QoL). Objective: This study aimed to assess the quality of life (QoL) in children with congenital birth defects in Bangladesh, focusing on the influence of age, type of defect, and surgical interventions. Methods: This prospective cohort study was conducted at the Department of Pediatrics, 250 bedded General Hospital, Nilphamari, Bangladesh from July 2023 to June 2024. A total of 200 children aged 5-18 years with documented congenital anomalies were selected. Data were collected through medical record reviews and structured interviews using the Pediatric Quality of Life Inventory (PedsQL). Statistical analyses, including Chi-square tests and ANOVA, were employed to assess the relationships between QoL scores, age, type of defect, and surgical interventions. Results: The study revealed that the mean PedsQL scores decreased with age, with the lowest scores observed in the 16-18 years age group. Congenital heart defects were the most prevalent, affecting 40% of participants, followed by neural tube defects (20%) and cleft lip/palate (15%). Children with CHDs and neural tube defects had lower QoL scores compared to those with other defects. Additionally, 90% of participants underwent surgical interventions, with multiple surgeries associated with lower QoL. Conclusion: The study highlighted the significant impact of congenital defects on QoL, particularly among older children and those with more severe conditions like CHDs and neural tube defects. These findings underscored the need for targeted interventions to improve the long-term QoL of affected children. J Rang Med Col. September 2024; Vol. 9, No. 2: 21-26

Reconstruction Using a Bilobed Flap in a Patient With Recurrent Neck Soft Tissue Metastasis From Oral Cancer: A Case Report.

Soft tissue defects in the head and neck are frequently encountered, often resulting from trauma or the surgical management of malignancies. Flap reconstruction plays a critical role in the closure of these defects, aiming to minimize complications and improve cosmetic outcomes. While various flap techniques are commonly utilized in head and neck reconstruction, to the best of our knowledge, the bilobed flap has not been previously reported in this anatomical region. We present a case involving a patient with a complex underlying medical condition, which elevated the risks associated with prolonged anesthesia. In light of these considerations, we opted to use a bilobed flap, which was successfully employed for the reconstruction of an intermediate-sized soft tissue defect in the right submental area following resection of recurrent oral cancer. After undergoing multiple surgeries and concurrent chemoradiotherapy, the 65-year-old male patient developed significant neck stiffness, making direct closure unfeasible and traditional local flap techniques ineffective for wound management. The bilobed flap was meticulously planned, with the first lobe positioned over the adjacent site of the right submental defect and the second lobe located next to the first lobe, employing a double transposition design. The flap healed without complications, and the patient experienced a good recovery. This case report underscores the effectiveness of bilobed flaps in reconstructing moderate-sized soft tissue defects in patients with recurrent neck metastatic oral cancer after previous neck dissection and concurrent chemoradiotherapy.

Postpanniculectomy Improvement in Low Back Pain: A Case Report

While panniculectomy is traditionally considered a cosmetic surgery, there is growing interest in the potential role of panniculectomy for the treatment of low back pain. We present a case of a 69-year-old man with a history of over 10 years of significant low back pain with radiculopathy rated as 7 out of 10 and resistant to conservative measures as well as multiple spinal decompression surgeries. He had undergone bariatric surgery 14 years prior and maintained a stable body mass index. He presented with a large pannus desiring panniculectomy for aesthetic purposes. He underwent an uncomplicated panniculectomy. As an unintended benefit of his procedure on his 1-month post-op visit, he reported near resolution of his low back pain and radiculopathy. His reported pain had been reduced to 1–2 out of 10. More research needs to be done to assess the potential of panniculectomy as a treatment for low back pain in patients with massive weight loss.

The Development of Multi-modal, pH-sensitive Quantum Dots for the Detection of Breast Cancer

In the current decade, a significant amount of women have been diagnosed with breast cancer. There is a one in eight chance that women will develop breast cancer. It consists of a high fatality rate and tragic death due to the existing barriers set by current methods that are accessible as a treatment for breast cancer. For example, most treatment plans include a combination of surgery, radiation, hormone therapy, chemotherapy, and targeted therapies. However, due to the collateral damage from multiple follow-up surgeries and subsequent infections, some patients are even averse to starting or continuing treatment. Chemotherapy can result in fatigue, pain in the fingers and feet, increased risk of infection, and more. Hormone therapy can result in similar symptoms but also include nausea, muscle and joint pain, and headaches. Especially breast biopsy, the removal of a sample of breast tissue for diagnosis, is very painful for patients. It takes multiple days to get a diagnosis. It also results in soreness, swelling, or bruising at the biopsy site. This article will attempt to address the current limitations of breast cancer diagnosis by suggesting an innovative method on multimodal pH and progesterone-sensitive quantum dots to detect breast cancer faster and cheaper. Just a sample of blood is needed from the patient, and the quantum dot sensor will detect the cancerous cells through the emission of wavelengths of about 475 and 1300 nm with a cyan color and infrared radiation. These wavelengths can be translated to quantitative graphs with a spectrophotometer. With its optical sensor, the quantum dot will significantly reduce the price of getting a diagnosis, and it will be able to diagnose the patient almost immediately. Further, it does not require a trained professional to diagnose, which is a significant improvement over the current techniques.

Role of optic zone diameter in scleral lens fitting in traumatic aniridia with scarred cornea – A case report

Scleral lenses (SLs) are large-diameter rigid gas-permeable lenses that vault over the entire cornea and rest on the bulbar conjunctiva overlying the sclera and maintain a fluid reservoir, which along with the rigidity of the lens masks irregular astigmatism and reduces the aberrations. A 20-year-old male had decreased vision, photophobia, and double vision due to an open globe injury with a shuttle bat 1 year back, followed by which he underwent corneal tear repair and multiple retinal surgeries. He was advised for penetrating keratoplasty elsewhere and came for a second opinion. Based on a diagnostic fitting approach, an 18.5 mm diameter SL was applied on the right eye, with which vision improved from 6/60, N36@ 10 cm to 6/7.5 and reduced the higher-order aberrations but a slightly higher vault was observed. Therefore, a 16.5 mm diameter SL was applied but with this lens, vision decreased to 6/12 with effort, and in both lenses, the patient reported binocular diplopia. Therefore, a combination of management, larger optic zone SLs, and a Fresnel prism was prescribed, which improved the patient’s vision, and reduced diplopia. The purpose of the case report is to emphasize the role of optic zone diameter in SL fitting, particularly in cases of traumatic scarred cornea with eccentric pupils and the importance of co-management.

Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort study

BackgroundResearch on factors influencing the outcomes of revision anterior cruciate ligament (ACL) reconstruction is relatively scarce and mostly relies even on reports from a single group. Understanding the factors contributing to the failure of revision ACL reconstruction can provide valuable information for achieving better clinical outcomes and assist in patient counseling before surgery. Therefore, this study aimed to analyze the factors contributing to surgical failure after revision ACL reconstruction.MethodsThe medical records of consecutive patients who underwent single-bundle revision ACL reconstruction using the transportal technique between 2010 and 2020 and had a minimum follow-up of 2 years were retrospectively reviewed. Eligible patients were classified into two groups on the basis of the presence of surgical failure during the follow-up period (group NF, patients who did not experience surgical failure; group F, patients who experienced surgical failure). In this study, surgical failure after revision ACL reconstruction was defined as meeting any of the following conditions during follow-up: the presence of graft re-tear confirmed by magnetic resonance imaging (MRI), anterior–posterior laxity graded ≥ 2, or rotational laxity graded ≥ 2. A comparative analysis was conducted on demographic data, as well as peri-, intra-, and postoperative data between the groups. Additionally, a regression analysis was performed to investigate factors influencing surgical failure after revision ACL reconstruction.ResultsA total of 58 patients were included (group NF, 40 patients; group F, 18 patients). In between-group comparisons of demographic, peri-, and intra-operative data, group F exhibited a higher frequency of multiple revision surgeries (P = 0.001), increased preoperative osteoarthritis grade (P = 0.001), and shallower femoral tunnel depth (P = 0.002) compared with group NF. At the final follow-up, group F demonstrated relatively poor clinical outcomes, both subjectively and objectively. Multivariate regression analysis revealed that all variables that showed differences in the preceding comparisons were independent factors affecting surgical failure after revision ACL reconstruction.ConclusionsSurgical failure after revision ACL reconstruction can occur in a substantial number of patients, influenced by non-modifiable factors, such as cases corresponding to multiple revision surgery and preoperative osteoarthritis grade, and modifiable factors, such as femoral tunnel depth.

Is It a Mind Game? Do Visual and Psychological Perceptions Differ Between Aesthetic Surgery Patients and Healthy Controls?

Aesthetic plastic surgery allows for the reshaping of the human body. Most research on aesthetic surgery has focused primarily on improving self-confidence. In this study, we aimed to assess the visual perception, body appreciation, body image quality of life, and satisfaction with life among aesthetic surgery patients, and compare these outcomes with those of healthy controls. A total of 57 aesthetic surgery patients and 56 healthy controls, with no history of psychiatric disorders, were included in the study. All participants completed the Motor-Free Visual Perception Test (3rd Edition), the Body Appreciation Scale (BAS), the Body Image Quality of Life Inventory (BIQLI), and the Satisfaction with Life Scale (SWLS). Participants with a history of psychiatric disorders and the surgeon's own revision patients were excluded. MVPT-3 scores were significantly lower in aesthetic surgery patients compared to healthy controls. Additionally, as the number of operations increased, MVPT-3 scores decreased. A similar trend was observed between MVPT-3 and BIQLI/BAS scores, where lower body image quality and appreciation were associated with reduced visual perception scores. Interestingly, satisfaction with life was not significantly affected. Evaluating visual perception in patients seeking multiple surgeries may help prevent negative outcomes and contribute to more positive surgical experiences. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Review of Long-Term Sequelae and Management in Paediatric Lower Limb Replantation.

Major limb amputation in a child is a rare but devastating injury associated with significant psychosocial and financial burden. This, combined with the higher growth and remodelling potential despite segmental limb loss, decreases the threshold for replantation in children. Advances in microsurgical techniques and a better understanding of such injuries have led to lower limb replantation becoming a feasible option, with good long-term functional outcomes, even in bilateral amputations. However, long-term sequelae such as limb length discrepancy (LLD) are common, and patients are often subject to multiple surgical interventions. We present a case of replantation in a 2-year-old child following traumatic right below knee amputation, followed up over a period of 5 years. After multiple surgeries, the patient gained good functional recovery and sensibility of the replanted limb. We reviewed and discussed the management of subsequent long-term sequelae, including LLD, lower limb contractures and valgus deformity. Level of Evidence: Level V (Therapeutic).

Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial.

Background: Aseptic nonunion of femoral shafts after intramedullary nailing (IMN) can be a challenging condition that may lead to long-term disability and the need for multiple surgical procedures. This study compared the clinical and radiological outcomes between exchange nailing and augmentative plating with bone grafting. Methods: In this multicenter, prospective, single-blind, randomized controlled trial, patients with aseptic nonunion of the femoral shaft after IMN were randomly assigned to receive exchange nailing or augmentative plating. The primary outcomes measured were the time to bone union and union rate 12 months after revision surgery. The secondary outcomes included operative time, blood loss, hospitalization duration, pain level using the visual analog scale (VAS), knee range of motion (ROM), and complication rates. Results: The augmentative plating group had a significantly shorter mean time to union (5.39 ± 1.29 months) compared with the exchange nailing group (7.38 ± 1.97 months; p < 0.001). The union rates at 12 months were 100% in the augmentative plating group and 89.65% in the exchange nail group. Augmentative plating resulted in a shorter operation time (99.46 ± 11.08 min vs. 106.45 ± 12.22 min; p = 0.025) and reduced blood loss (514.79 ± 45.87 mL vs. 547.72 ± 54.35 mL; p = 0.016). Significant pain reduction was observed in the augmentative plating group, with preoperative VAS scores decreasing from 6.04 ± 2.28 to 2.64 ± 1.50, compared with a decrease from 5.66 ± 2.21 to 3.66 ± 2.19 in the exchange nailing group (p = 0.047). Knee ROM improved significantly in the augmentative plating group (p = 0.0176). The complication rate was lower in the augmentative plating group (3.57%) than in the exchange nail group (17.24%). Conclusions: Augmentative plating with autologous bone grafting is superior to exchange nailing for treating aseptic nonunion of femoral shafts. It is associated with faster healing, higher union rates, better clinical and functional outcomes, and fewer complications. We recommend this technique as the preferred treatment option for such complex cases.

Advanced treatment-resistant ovarian germ cell tumor (yolk sac tumor) with successful fertility realization 20 years after combined treatment: a case report

Background. Yolk sac tumors (YST) are classified as rare malignant germ cell tumors of the ovaries, most commonly found in young patients interested in preserving fertility. YST is characterized by large size, predominantly unilateral involvement, and increased production of alpha-fetoprotein, which can be used as an important diagnostic criterion for this condition. Among all germ cell tumors, YST has the least favorable prognosis. The primary goals of YST treatment are not only to improve prognosis and quality of life but also to enable the patient to fulfill her reproductive plans in the future.Description of the clinical case. We present a clinical case of an aggressive course of yolk sac tumor in the ovary of a 15-year-old girl, requiring multiple surgeries, repeated courses of high-dose drug therapy, and bone marrow transplantation.Conclusion. This is a rare case of YST with successful preservation of reproductive function due to modern medical technologies despite aggressive treatment.

Utilization Fraction of Ambulatory Hand Procedures: Cost-Reduction Through Surgical Instrument Tray Optimization.

Our objective is to evaluate the utilization fraction (UF) of surgical instruments during a commonly performed ambulatory hand surgery case as an avenue for cost reduction, increased operating room efficiency, and systems quality improvement. The total number of instruments opened at the start of the case was recorded followed by instruments being divided into those used and not used during the procedure. Total sterile processing costs were estimated at $1.56 per instrument according to data from our institution's central sterilization processing (CSP) department. Nineteen hand procedures performed by 2 surgeons were included in this study. An average of 120.1 ± 10.9 instruments were opened at the start of each case, while an average of 12.6 ± 5.4 instruments were used per case (Figure 1). This yielded an UF of 10.7% ± 4.8%. Using our internal CSP estimate, we calculated an annual cost of $16 863 to reprocess the current hand tray (Figure 2). Using literature data, this cost ranged from $5 513 to $34 484 annually. The same cost calculations were performed for the theoretical optimized tray (incorporating instruments used at least 20% of the time when opened) containing 23.2 instruments. The annual reprocessing cost of this new tray according to CSP data was $3 260, demonstrating a cost-reduction of $13 603 or 80.7% (Figure 2). Evaluation of pre- and peri-operative processes is a valuable technique to mitigate increasing healthcare costs and reduce unnecessary healthcare spending, with broad applicability to multiple surgical subspecialties and procedures.

Surgical Considerations in the Management of Constriction Ring Syndrome.

Surgical management of constriction ring syndrome (CRS) is individualised due to the heterogenic presentation of the condition. CRS includes constriction rings, acrosyndactyly, nubbins and short digits. Involvement of more than one limb is common and children often need multiple surgeries. Each limb may need staged surgeries. If the child has vascular or lymphatic compromise secondary to a constriction ring, the ring needs to be excised and released in the first few days of life. The rings are released using multiple big Z-plasties in one or two stages. Nerve palsy associated with the rings need early intervention. Tendon transfers may be advised when nerve procedures like neurolysis and nerve reconstruction fail. Acrosyndactyly can be corrected with separation of the fused fingertips. At times, the web is more distal than usual and requires web deepening using partial syndactyly separation techniques and may need full thickness skin grafting. Complex type of acrosyndactyly is difficult to treat as it needs proper planning and staged surgical correction to achieve a five-digit hand. Separation of the syndactyly with web deepening gives more functional length and independence to the digits. The short fingers, especially the thumb, need reconstruction. Non-vascularised toe phalangeal transfer or a microvascular toe transfer can reconstruct a missing digit. Level of Evidence: Level V (Therapeutic).

Natural evolution of a cesarean scar pregnancy up to 34 weeks complicated by an early subserosal uterine rupture and placenta accreta spectrum disorders

Cesarean scar pregnancy (CSP) is an extremely rare form of ectopic pregnancy. A 39-year-old woman with a history of multiple uterine surgeries was diagnosed with a CSP at seven weeks by transvaginal ultrasound. The CSP was misdiagnosed at 13 weeks and 5 days during a second medical opinion. At 22 weeks of gestation, a 3.8 cm subserosal uterine rupture was visualized. Expectant management was decided. A live birth was achieved through an elective cesarean section at 34 weeks of gestation. The complications were early subserosal uterine rupture and placenta accreta spectrum that led to a hysterectomy. Due to risk of uterine rupture, management should consist of early termination of the pregnancy.

Factors contributing to severe scoliosis after open chest surgery for congenital heart disease: a case-control analysis.

Previous reports have identified factors associated with open chest surgery for congenital heart disease (CHD) and scoliosis. However, these reports included conditions such as Down syndrome and Marfan syndrome, which involve both cardiac disease and scoliosis. The relationships between these factors and open chest surgery remain unclear. This study aimed to identify factors contributing to severe scoliosis in CHD patients who have undergone open chest surgery. Seventy-four post-CHD surgery patients with severe scoliosis (Scoliosis group) and 30 post-CHD surgery patients without scoliosis (NS group), excluding those with any syndrome or intellectual disability, were retrospectively analyzed. Patient background characteristics and radiographic parameters were compared between the NS and Scoliosis groups. Furthermore, the patients in the Scoliosis group were classified into three categories, namely, mild scoliosis, moderate scoliosis, and severe scoliosis, and the results were compared among the four groups. Eighteen patients in the NS group and 63 in the Scoliosis group met the inclusion criteria. Compared with the NS group, the Scoliosis group included significantly more girls and patients who had younger ages at first CHD surgery and multiple open chest surgeries. Severe scoliosis progression was observed in patients who underwent multiple surgeries for severe CHD with cardiomegaly. Progression to severe scoliosis was noted in patients with younger ages at first CHD surgery and those who underwent multiple surgeries for severe CHD. Assessing spinal deformities should be a key aspect of postoperative care for CHD, particularly in patients with severe CHD who are undergoing multiple chest surgeries. III.

CSIG-08. AGGRESSIVE HIGH-GRADE NF2 MUTANT MENINGIOMAS DOWNREGULATE ONCOGENIC YAP SIGNALING VIA THE UPREGULATION OF VGLL4 AND FAT3/4

Abstract Meningiomas are the most common primary brain tumors in adults. Although generally benign, a subset is of higher grade, shows aggressive growth behavior and recurs even after multiple surgeries. Around half of all meningiomas harbor inactivating mutations in NF2. While benign low-grade NF2 mutant meningiomas exhibit few genetic events in addition to NF2 inactivation, aggressive high-grade NF2 mutant meningiomas frequently harbor a highly aberrant genome. We and others have previously shown that NF2 inactivation leads to YAP1 activation and that YAP1 acts as the pivotal oncogenic driver in benign NF2 mutant meningiomas. Using bulk and single-cell RNA-Seq data from a large cohort of human meningiomas, we show that aggressive NF2 mutant meningiomas harbor decreased levels YAP1 activity compared to their benign counterparts. Furthermore, decreased expression levels of YAP target genes are significantly associated with an increased risk of recurrence. We then identify the increased expression of the YAP1 competitor VGLL4 as well as the YAP1 upstream regulators FAT3/4 as a potential mechanism for the downregulation of YAP activity in aggressive NF2 mutant meningiomas. High expression of these genes is significantly associated with an increased risk of recurrence. In vitro, overexpression of VGLL4 resulted in the downregulation of YAP activity in benign NF2 mutant meningioma cells, confirming the direct link between VGLL4 expression and decreased levels of YAP activity observed in aggressive NF2 mutant meningiomas. Our results shed new insight on the biology of benign and aggressive NF2 mutant meningiomas and may have important implications for the efficacy of therapies targeting oncogenic YAP1 in NF2 mutant meningiomas.

Malignant transformation of vestibular schwannoma 29 years after Gamma Knife radiosurgery: illustrative case.

Vestibular schwannomas are common posterior fossa tumors, often managed with stereotactic radiosurgery (SRS) due to its low invasiveness and high tumor control rates. However, malignant transformation of vestibular schwannoma (MTVS) is a rare but serious complication with a poor prognosis. The authors present a case of MTVS occurring 29 years after initial SRS, the longest latency reported. A 68-year-old woman developed sudden facial nerve paralysis, with magnetic resonance imaging revealing tumor regrowth. Surgical removal and histopathological analysis confirmed malignant transformation, characterized by spindle-shaped atypical cells and significant p53 positivity. Despite multiple surgeries and radiation therapy, the tumor exhibited rapid regrowth and cerebrospinal dissemination, leading to a poor prognosis. This case underscores the critical importance of long-term monitoring after SRS, as malignant transformation can occur decades later. Additionally, it highlights the potential necessity for early intervention during malignant transformation to improve patient outcomes, despite the challenges in identifying effective treatments for MTVS. https://thejns.org/doi/10.3171/CASE24526.

Endoscopic Minimally Invasive Approach Versus Median Sternotomy for Multiple-Valve Surgery: A Propensity-Matched Analysis.

Endoscopic minimally invasive valve surgery is a promising alternative to valve surgery through median sternotomy. Our study compared the short-term outcomes of patients undergoing endoscopic minimally invasive multiple concomitant valve surgeries (MIMVS) with median sternotomy (MS). Demographic, clinical, and procedural data of all consecutive patients who underwent multiple-valve surgeries at two institutions in Germany from March of 2017 to March of 2023 were retrospectively collected. Patients were divided into two groups: MIMVS versus MS and their outcomes were compared before and after propensity score matching. Primary endpoint was the incidence of 30-day mortality. A total of 317 patients were included in the study; 112 patients in each group were matched 1:1. MIMVS was performed on 123 patients. After propensity matching, 30-day mortality rates were 8% for MIMVS versus 12.5% for MS (p = 0.28). Median blood transfusion in the MIMVS group was 0 [0-3] vs 1 [0-4] in the MS group (p = 0.002). MIMVS was associated with similar cardiopulmonary bypass time 105.5 [79.8-124] versus 98 [68.8-130.3] mins and aortic cross clamping times 70 [53-80.3] versus 63.5 [46-90.3] mins (pvalues 0.9 and 0.76, respectively). Median intensive care and inhospital stays were similar between both groups (2 [1-4] vs 2 [1-5] days, p = 0.36, and 12 [8-17] vs 12.5 [9-21] days, p = 0.38). Incidences of intrathoracic bleeding, stroke, and acute kidney injury were similar in both groups. In our experience, endoscopic minimally invasive multiple-valve surgeries through right anterior mini-thoracotomy is as feasible, safe, and effective as medial sternotomy in select patients.

Re-excision rates after breast-conserving surgery for invasive breast cancer: an Albertan perspective.

Re-operation after breast-conserving surgery for invasive breast cancer is variable among centres and individual surgeons. In this study, we aimed to characterize the current landscape of practice regarding re-operation for invasive breast cancer in the province of Alberta. This study was a retrospective review of the Synoptec database for patients undergoing primary breast-conserving surgery for invasive breast cancer or reoperation in the province of Alberta in the year 2020. We extracted data on demographic and tumour characteristics, use of intraoperative margin-assessment strategies, and surgical facility. We conducted univariate and multivariate logistic model analyses. We included 1391 breast surgeries in the study. A total of 158 patients underwent re-operation during the study period. The median time to first reoperation was 34 days. The overall re-operation rate was 11.4% (range 5.4%-18.5%) among surgical facilities. The completion mastectomy rate was 5.2%, and 1.5% of patients underwent multiple revisional surgeries. Tumour multifocality was associated with increased revisional surgery rates on multivariate analysis (odds ratio 2.80). The results of this study are consistent with the published literature. We have identified heterogeneity among sites in Alberta for revisional surgery after breast-conserving surgery for invasive breast cancer. This highlights an opportunity for ongoing education and quality improvement in breast cancer care in the province of Alberta.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

Pedal medial artery calcification score as a prognostic marker for the success of surgical intervention in diabetic foot disease

AbstractAims: This study aimed to investigate for a causal link between severity of pedal medial artery calcification (pMAC) and the success of surgical interventions in the treatment of diabetic foot ulceration (DFU). Our secondary aim was to compare pMAC and traditional vascular studies used in the preoperative assessment for surgical interventions in DFU.Methods: A single‐centre, retrospective observational study was performed for patients undergoing debridement or amputation for DFU between October 2019 and March 2023. Patient pMAC scores were calculated using the Ferraresi classification. Doppler ultrasound studies were recorded to assess for peripheral artery disease (PAD). Patient outcomes were recorded from available follow‐up data.Results: A total of 70 limbs were identified; 73% had no pMAC, 16% had moderate pMAC and 11% had severe pMAC. Limbs with pMAC were more likely to need multiple surgeries (no pMAC, 37%; moderate pMAC, 55%; severe pMAC, 50%), with amputation twice as likely (42%, n=8) vs the no‐pMAC group (20%, n=10). In addition, 74% of the patients with pMAC had no indication of PAD on Doppler studies.Conclusions: Our findings show a trend between pMAC severity and prognosis after DFU‐related surgery. We identified worse outcomes from DFU‐related surgery with increasing pMAC severity. Patients were more likely to require multiple surgeries with pMAC and twice as likely to require future amputation. Vascular studies gave inconsistent findings with patient outcomes. The pMAC score is cheap and easy to calculate from routine x‐rays. It has the potential to be an important prognostic indicator for DFU‐related surgery; however, further studies are required.